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PEDIATRIC ANESTHESIA

The Effect of Fentanyl on the Emergence Characteristics After Desflurane or Sevoflurane Anesthesia in Children

Departments of Anesthesiology and Pediatrics, Children’s National Medical Center and George Washington University Medical Center, Washington, DC

Address correspondence and reprint requests to Ira Todd Cohen, MD, Department of Anesthesiology, Children’s National Medical Center, 111 Michigan Ave., NW, Washington, DC 20010. Address e-mail to icohen{at}cnmc.org

Desflurane and sevoflurane anesthesia are associated with emergence agitation in children. In this study, we examined the effect of a single intraoperative dose of fentanyl on emergence characteristics in children undergoing adenoidectomy. One hundred children, 2–7 yr old, were randomly assigned to receive desflurane or sevoflurane for maintenance of general anesthesia after an inhaled induction with sevoflurane and a 2.5 µg/kg dose of fentanyl. An observer blind-ed to the anesthetic technique assessed the times to achieve emergence, extubation and recovery criteria, as well as emergence behaviors. The results showed a similar incidence of severe emergence agitation after general anesthesia with desflurane (24%) and sevoflurane (18%). Times to achieve extubation and postanesthesia care unit discharge criteria were shorter with desflurane than with sevoflurane. With this technique, desflurane allows for a more rapid emergence and recovery than sevoflurane. In children receiving desflurane or sevoflurane, the concurrent use of fentanyl in a dose of 2.5 µg/kg results in a small incidence of emergence agitation.

IMPLICATIONS: The concurrent use of fentanyl in a dose of 2.5 µg/kg in children receiving desflurane or sevoflurane results in a low incidence of emergence agitation. Desflurane allows for a more rapid emergence and recovery than sevoflurane.

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